We follow a population-based cohort of Pima Indians who are invited every two years to participate in a research examinination. The methods for this longitudinal study are described in detail in Project Numbers Z01 DK069097 and Z01 DK069000. Electrocardiograms are obtained and serum total cholesterol, HDL cholesterol, and triglycerides are measured at each of these examinations. Participants with amputations are identified and the level of amputation is recorded. A death registry is maintained and underlying causes of death are determined by review of clinical records, autopsy reports and death certificates. Terminology and codes of the International Classification of Disease, Ninth Revision (ICD-9), are used to classify causes of death. In the past year, we found that the incidence rate of ischemic heart disease and natural mortality are not increased in Pima Indians with impaired glucose regulation. Only after the onset of diabetes do the rates of these events increase relative to normal glucose regulation. In the coming year, we will characterize, among other things, the impact of heart rate and prolonged QT interval on mortality. Changes in management of diabetes will be examined to determine whether improvements in health services are reflected by improvements in blood pressure, glycemic, and lipid control. The Look AHEAD clinical trial of weight loss to prevent complications of type 2 diabetes has completed at least three years of observation on all participants.